In their 10th annual letter, the philanthropists lay out their philosophy for funding global health initiatives–and why the President’s budget, which slashes foreign aid, is antithetical to American well-being.

On February 13, Bill and Melinda Gates released their annual letter–a yearly update on the Gates Foundation, and insights into their work. This year’s marked the 10th anniversary of the letter, and in it, they tackle 10 of the toughest questions about their philanthropic work that they’ve had to answer in recent years.

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Those questions ranged from “Why are you really giving your money away–what’s in it for you?” to “Why don’t you give more in the United States?” The latter was inspired by the fact that of the roughly $4.5 billion in grants the Gates Foundation doles out each year–both Bill and Melinda have pledged to give away the majority of their wealth over their lifetimes–around $500 million goes to the U.S., while the rest they funnel into the developing world.

[Image: Andrey_A/iStock]

To answer that question, which Bill and Melinda did to a room full of students at the public unveiling of the letter at Hunter College in Manhattan in a discussion moderated by Hunter College High School alum and Hamilton creator Lin-Manuel Miranda, the Gates’ had some very recent fodder: President Trump’s latest budget proposal, which was released just the day before their letter went public.

In it, Trump proposes reducing the foreign aid budget by 30%, from nearly $60 billion to around $40 billion, writing that “it is time to prioritize the security and well-being of Americans, and to ask the rest of the world to step up and pay its fair share.”

[Image: Andrey_A/iStock]

To the Gateses, this line of thinking is antithetical to the work of their foundation, which takes the approach of tackling systemic barriers to equality–between nations, and between communities within nations–with the recognition that these barriers are not the making of poorer countries, but in many cases, aided and abetted by forces beyond their control, like disease and increasingly, severe and unpredictable climate patterns. (One of the most contentious of the 10 questions addressed in their letter relates to Trump’s policies and their effect on the work of the Gates Foundation). Following this logic, the Gates Foundation has spent $15.3 billion on vaccines over the past 18 years, and recently announced that it paid off the entirety of Nigeria’s $76 million debt for vaccines to eradicate polio.

“While it seems like our resources are huge, they’re actually limited,” Melinda says, speaking at Hunter College. While the foundation has ample financial resources to fund initiatives like ending polio and boosting access to contraception in developing countries–a particular project of Melinda’s–government cooperation and sign-on, she says, is essential to their work. And under the Trump administration, the Gateses are worried their work will miss that public-sector support.

[Image: Andrey_A/iStock]

While Trump claims that his strategy to slash foreign aid and global health initiatives falls in line with his “America First” approach, the Gateses argue that America withholding its resources in that regard will create harmful repercussions for both developing countries and America itself. Trumps’ latest budget, for instance, proposes reducing funding for the Global Health Security Agenda, a program set up to identify and curtail outbreaks of deadly diseases, from $180 million to $60 million per year, and as a result, force the Centers for Disease Control and Prevention to downsize or close its operation in 39 countries. Speaking at Hunter College, Bill says that constricting funding for global disease maintenance could increase the likelihood of a major outbreak in the U.S. It was the health workers already on the ground in Nigeria, Melinda says, that prevented Ebola from spreading farther than it did.

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And what’s especially egregious about Trump’s insistence on slashing foreign aid, Melinda says, is that the money the U.S. funnels into global development makes up just around 1% of the U.S.’s total budget. While in the U.S. context, it’s just a drop in the bucket, “even a 10% cut in aid would mean another 5 million deaths over the next decade,” Melinda says.

If you have the resources and means to reach people and make a positive impact on entrenched issues like health and generational poverty, the Gateses believe, it’s incumbent upon you, whether “you” is an individual or a nation, to use those means to the greatest benefit. Trump’s insistence on hoarding the resources of America, the wealthiest country in the world, is antithetical to that view. As Bill writes in the letter: “My view is that engaging with the world has proven over time to benefit everyone, including Americans, more than withdrawing does. Even if we measured everything the government did only by how much it helped American citizens, global engagement would still be a smart investment.”

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About the author

Eillie Anzilotti is an assistant editor for Fast Company's Ideas section, covering sustainability, social good, and alternative economies. Previously, she wrote for CityLab.